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Resolution of Acanthamoeba Keratitis with Adjunctive Use of Oral Miltefosine
Ema Avdagic1, Hall F Chew2, Peter Veldman1
1Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA.
Abstract:
Purpose: To report a series of cases demonstrating the resolution of Acanthamoeba keratitis (AK) with adjunctive use of oral miltefosine.Methods: Retrospective case series.Results: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.Conclusions: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.
Insights
Oral miltefosine shows promise in treating Acanthamoeba keratitis (AK), a severe eye infection. This adjunctive therapy may be effective, especially for cases with many cysts or those resistant to other treatments.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Parasitology
Background:
- Acanthamoeba keratitis (AK) is a serious microbial infection of the cornea.
- It can lead to significant visual impairment and is often challenging to treat.
Observation:
- Two cases of Acanthamoeba keratitis are presented.
- Both patients received adjunctive oral miltefosine therapy.
- Confocal microscopy revealed a high burden of Acanthamoeba cysts in one case.
Findings:
- Adjunctive oral miltefosine therapy led to the resolution of Acanthamoeba keratitis in both cases.
- Rapid improvement was observed after initiating miltefosine treatment.
- The drug may possess cysticidal properties against Acanthamoeba.
Implications:
- Oral miltefosine could be a valuable addition to AK treatment protocols.
- It may be particularly beneficial for severe or refractory AK cases.
- Further research into miltefosine's efficacy and mechanism in AK is warranted.
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